IOL (Intraocular Lens Implants) — Lens Replacement & Cataract Surgery

In my clinic this yesterday a very nice lady, highly educated, came to see me for a routine eye check. She was diabetic so needed a retinal check annually and had conscientiously turned up for this. In our way of working, irrespective of what you come for (your ‘presenting complaint’) you get a full and thorough eye check, which she had. Her spectacle prescription had changed, so that was prescribed. On asking about family history she volunteered that her mother had glaucoma and her aunt may have had it (but she was not sure). Her eye pressure (intraocular pressure, IOP) was 26 in Tonometryeither eye, checked by the gold standard method (Goldman applanation tonometry – many clinics rely on non contact tonometry – the ‘air puff’ which is less accurate), and her optic discs looked suspicious of glaucoma. Happily she had no signs of diabetic retinopathy. So although I could reassure her on the diabetic retinopathy issue, the reason she had come to me in the first place, I requested further tests to establish or rule out glaucoma. A standard glaucoma workup these days includes a perimetry (visual field test), CCT (Central corneal thickness – as this can influence IOP readings) and a study of the optic nerve head, using one of mainly three modalities – the commonest today is probably an optical coherence tomogram – OCT – but a GDX or HRT (Heidelberg Retinal TomoOptic Nerve OCTgram) are also used. The particular choice of optic nerve study depends on local availability, the familiarity of the doctor with a certain technology and his/her confidence in that technology. So I ordered a Perimetry, CCT, and an OCT RNFL (Optical Coherence Tomograph of the optic nerve head measuring the Retinal Nerve Fibre Layer).Glaucoma is well known as the ‘silent thief of vision’, patients are asymptomatic until they loose a lot of vision, and any damage done is irreversible, treatment can only realistically aim at preserving what is not lost already and at slowing down progression of loss, if further loss cannot be stopped. It is a bit like me taking my blood pressure and cholesterol tablets every morning – they do not make me feel better, but I know that they reduce the risk of serious adverse events in the future , so I take them and see my physician every few months to have my parameters checked.

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